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Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?

  • V. A. Reva
  • Y. Matsumura
  • T. Hörer
  • D. A. Sveklov
  • A. V. Denisov
  • S. Y. Telickiy
  • A. B. Seleznev
  • E. R. Bozhedomova
  • J. Matsumoto
  • I. M. Samokhvalov
  • J. J. Morrison
Original Article

Abstract

Purpose

The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock.

Methods

Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage.

Results

Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals.

Conclusions

In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

Keywords

Resuscitative endovascular balloon occlusion of the aorta REBOA Hemorrhagic shock Ovine model Ischemia–reperfusion injury 

Notes

Compliance with ethical standards

Funding

Viktor Reva and Sergey Telickiy received a Grant from the President of Russia #MK-7508.2016.7 to conduct this study.

Conflict of interest

Yosuke Matsumura is a clinical advisory board member of Tokai Medical Products. Jonathan Morrison is a clinical advisory board member of Prytime Medical Inc. Tal Hörer, Denis Sveklov, Alexey Denisov, Alexey Seleznev, Elvira Bozhedomova, and Igor Samokhvalov declare that they have no conflict of interest.

Ethical approval

All procedures performed in this experimental study were in accordance with the ethical standards of the Kirov Military Medical Academy and National Institutes of Health guide for the care and use of laboratory animals. The local institutional ethics committee approved the study (protocol no. 163/2015).

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • V. A. Reva
    • 1
  • Y. Matsumura
    • 2
    • 3
  • T. Hörer
    • 4
  • D. A. Sveklov
    • 1
  • A. V. Denisov
    • 1
  • S. Y. Telickiy
    • 1
  • A. B. Seleznev
    • 1
  • E. R. Bozhedomova
    • 1
  • J. Matsumoto
    • 5
    • 6
  • I. M. Samokhvalov
    • 1
  • J. J. Morrison
    • 7
    • 8
  1. 1.Department of War SurgeryKirov Military Medical AcademySaint-PetersburgRussian Federation
  2. 2.R. Adams Cowley Shock Trauma CenterUniversity of MarylandBaltimore, MDUSA
  3. 3.Department of Emergency and Critical Care MedicineChiba University Graduate School of MedicineChibaJapan
  4. 4.Department of Cardiothoracic and Vascular SurgeryÖrebro University HospitalÖrebroSweden
  5. 5.Departments of Emergency and Critical Care MedicineSaint-Marianna University School of MedicineKawasakiJapan
  6. 6.Department of RadiologyNational Hospital Organization Disaster Medical CenterTachikawa, TokyoJapan
  7. 7.Department of Vascular SurgerySouth Glasgow University HospitalGlasgowUK
  8. 8.The Academic Department of Military Surgery and TraumaRoyal Centre for Defence MedicineBirminghamUK

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